There are some very basic ingredients that comprise the various
types of skin peels and therapies. What differs primarily is the
percentage concentration of the main ingredient within the
formulation, and the type of ingredient necessary for the depth of the
peel. Often, a dermatologist or cosmetic surgeon will vary the
ingredient strength within the formulation based on the individual
needs of the patient.
I have presented an overview of the types of skin peels, the major
ingredients utilized, and the pros and cons associated with each type.
"Chemical Peels are procedures that remove the upper parts of the skin
allowing recovery and re-growth of the surface. This relies on
initially wounding the skin which stimulates growth of fresher, newer
looking skin. The peels can either be superficial or quite deep into
the dermis. Superficial peels include glycolic acid preparations. The
deeper peels such as trichloroacetic acid and phenol are used less
often. These produce more benefit but also carry an increased risk of
pigmentary changes or possibly very superficial scarring. Recovery is
quicker with the more superficial peels and may take weeks with the
deeper procedures. The peels treat fine lines, age spots and uneven
"There are quite a number of Chemical Face Peeling agents and these
can be combined with other agents to achieve different responses and
results depending on the desires of the patient and the experience of
the facial plastic surgeon. A short list of exfoliating agents
includes the following: trichloroacetic acid (TCA), alpha-hydroxy
acids, including glycolic acid, phenol, salicylic acid, lactic acid,
alpha-keto acids, tretinoin or retinoic acid, or resorcinol."
TYPES OF CHEMICAL PEELS
A very good overview of the different types of chemical peels can be
found on the International Rocacea Foundation website. Chemical peels
run from the "very superficial" all the way to "deep peels." The main
ingredient and it's concentration depends on the depth of the peel
THE SUPERFICIAL CHEMICAL PEELS
"This really isn?t a true peel, more of an exfoliation. The most
superficial layers of the stratum corneum (at the top of the
epidermis) is removed or thinned during exfoliation. Most chemical
peels have a preoperative regimen of using exfoliating agents such as
Renova, Tazorac or a strong glycolic acid cream for 2-4 weeks prior to
the actual procedure. This helps the chemical peeling agents penetrate
more deeply and evenly. The use of these exfoliants also have the
obvious beneficial properties of smoothing out thickened rough areas,
helping self tanners go on more evenly and helping other skin
rejuvenation products reach deeper tissues. Additionally, there has
been good evidence that vitamin A exfoliants can help stimulate
"Superficial chemical peels remove skin through a portion or the
entire epidermal layer. These are the "refreshing" forms of skin
peels. They can also help with reducing the appearance of very mild
blotchy skin discoloration, remnant acne discoloration and help
cleanse the pores.
* This is the most common form of peel that you would find performed
in a spa or by an aesthetician.
* Higher levels of glycolic acid are typically used by physicians
falling toward the Medium range. Resorcinol peels can cause a slightly
deeper peel much like sunburn."
"Superficial peels do not interfere with your normal everyday
activities, so you need not take time off work or stay at home out of
the public eye. In other words, these peels are a full treatment
program over several months. The peels should be performed weekly, as
they contain a concentration of ingredients which are far higher than
those sold over the counter or applied by beauty therapists. It is
also important not to abandon this treatment prior to having had the
full course, because the treatments are cumulative and the previous
one enhances each subsequent treatment. The ideal number of treatments
is six. Several days after each of the peels, flaking or light peeling
of the skin will occur. Subsequent weekly peels have their strength
and length of application adjusted according to your individual
previous response. It may be important to combine the regular
applications at the clinic with an ongoing treatment, which you
perform yourself, using special creams, on a daily basis. After your
treatment, it is recommended that you have a peel done every 2 to 3
months as on-going maintenance."
"Active ingredients used in mild to moderate chemical peels:
* Glycolic Acid (AHA)
* Salicylic Acid (BHA)
* Lactic Acid
* Jessner?s Peel (a combination of salicyclic acid, resorcinol and lactic acid
mixed in ethanol)
* TCA (Trichloracetic Acid) TCA is used in a variety of peeling regimens such
as AccuPeel and the Obaji Blue Peel."
THE DEEP CHEMICAL PEELS
"The superficial peels extend 0.06mm to the papillary dermis, while
the deep chemical peels extend 0.45 mm to the upper reticular dermis,
causing extensive shedding of the upper skin layers. Your skin will
look as if it has had a very severe sunburn, so most patients choose
to remain at home and out of the public eye for 5-7 days. However you
are welcome to leave the house, as long as you don't go out in the sun
at all, exercise heavily causing excessive sweating, or move your
facial muscles more than absolutely necessary, as this may cause
premature peeling of the skin resulting in scarring. Your skin needs
to be pre-treated for two weeks prior to the procedure, with Retin-A
cream and hydroquinone cream. These creams prime the skin, and prevent
hyperchromasia (darkening) occurring after the peel."
* "The peel consists of a high concentration of trichloroacetic acid
(TCA), which burns, when applied.
"For this reason, it must be applied in an operating room under very
controlled conditions, so that treatment can be given to help prevent
any pain. During the peel, your skin will blanche (whiten) and then
turn pinkish in color. Over the next few days, the skin will peel
extensively. It is important not to pick at it. You will be given
clear instructions on your follow-up skin care program at home. Seven
to ten days after the procedure, you will be advised to continue using
hydroquinone cream, and permit the use of makeup once all the scabs
These complications can occur with the application of chemical peels:
* Excessive redness and peeling of the skin
* Hypopigmentation (lightening of the skin color)
* Hyperpigmentation (darkening of the skin color)
* Active ingredients used in deep chemical peels: Baker?s Phenol
Medium Chemical Peel
"This type of peel goes through the epidermis, down into the upper
most portion of the dermis known as the papillary dermis.
* Medium peels are the level when complications are more likely to start.
"In addition to the pre-peel use of exfoliants, the use of a skin
bleaching agent, such as 4% hydroquinone, and a broad-spectrum
sunscreen a month prior to the procedure, may be added for more
aggressive forms of these peels, or for patients who already suffer
from some form of skin discoloration. Inflammation from this level
peel may temporarily produce an increase in skin tone. Medium peels
are typically not appropriate for people with darker skin tones or of
ethnic background again due to the risk of irregular pigmentation
following the procedure."
"Dealing with infection preventatively is important here. For
non-buffered glycolic acid and more commonly TCA peels, the use of
antiviral medication (herpes prevention) started before the peel is
performed is very helpful. The use of antibiotics is sometimes also
used. It is absolutely CRUCIAL that you not pick at the peeling skin
during the healing phase. This is a sure way to end up with an
infection and long lasting problems such as scarring or skin
discoloration. Often the use of emollients during the first few days
is incorporated in addition to the continued use of sunscreen, and a
very mild cleansing agent. Make-up is often avoided until the skin has
fully peeled away. Buffered peels such as the M.D. Forte Glycolic Acid
peels that range from 70-99% do not cause the type of significant
noticeable peeling that you can see with peels such as AccuPeel.
However, a series ranging from 6-12 Forte peels compared to usually 1
of the AccuPeel are utilized. Skin sensitivity, degree of skin
concerns, time down, and cost will determine the selection."
Examples of chemicals used for a medium peel include:
* Glycolic Acid 70%+ (non-buffered),
* TCA 35-70%,
* combination peels such as solid CO2 followed by medium strength TCA, and
glycolic acid followed by TCA.
"This peel goes through the epidermis, papillary dermis and into the
deeper portion of the dermis known as the reticular dermis. These
peels are not a simple procedure. Absorption of the active ingredient,
phenol, has been known to cause cardiac arrest and even death.
Patients who undergo phenol peels should be placed under general
anesthesia and on full cardiac and pulmonary monitoring. This is one
of those procedures that emergency back-up is going to determine the
outcome if something goes wrong. An anesthesiologist should be
present, and preferably have this procedure done in a surgical
setting, not just a room adjacent to the doctor?s office. The down
time from this procedure is obviously the longest, 2-3 weeks is
generally required before you want to be seen in public. Due to the
depth of the peel leaving deeper tissue exposed, there is an increase
in photosensitivity to the sun.
* Examples of ingredients used in deep peels include: Baker?s phenol
alone or under occlusion by tape.
See the International Rosacea website for more information
Another good overview about the types of Chemical Peels can be found Mamashealth
The number of layers and the intensity of the chemical peel solution
are individualized according to your skin type, skin color and the
condition being treated.
Type of Chemical Peel?
There are 3 main types of chemical peels
1. Superficial peels
* Superficial chemical peels are the mildest type of chemical peel and can be
used on all skin types.
* Superficial chemical peels usually use liquid containing a dilute acid,
most often glycolic acid.
* Dry ice solid carbon dioxide is sometimes used.
2. Medium peels
* Medium chemical peels penetrate the skin more deeply than superficial peels
and cause a second-degree burn of the skin.
* Trichloroacetic acid is the main peeling agent used for medium peels.
* Medium chemical peels may be done in several steps using a different
chemical solution followed by Trichloroacetic acid.
3. Deep peels
* Deep chemical peels penetrate several layers of skin and cause a
second-degree burn of the skin.
* They are the strongest kind of chemical peel and are used only on the face.
* Deep chemical peels are reserved for individuals with deep wrinkles from
sun exposure or is used to treat skin wrinkling around the lips and chin
* Deep peels tend to bleach darker skin .
* A deep peel can be done only once in most cases
How to Prepare for a Chemical Peel?
During the week leading up to the peel:
* avoid sun exposure
* do not use scrubs or masks
* do not apply a tanning solution to your skin
* do not wax, bleach or pluck
What to Expect During a Chemical Peel?
"The entire chemical peel procedure takes about 45 minutes. During the
chemical peel, you will probably feel a burning or stinging sensation.
This stinging sensation is felt after each layer is applied to the
skin. Stinging should not last more than a minute. The "stinging" is
cooled down with a fan. You should not experience any pain once you
leave the office or during the peeling process."
What Happens the days Immediately Following a Chemical Peel?
During the three to four days immediately following a chemical peel,
most people have the following experiences:
1. Increased Sensitivity
2. Redness - blotchiness
3. Tightness and Dryness
4. Swelling and scabbing
* Deeper peels usually scab and swell.
"After a chemical peel, your doctor may recommend follow up care.
Followed up treatments are usually designed to enhance the skin's
regenerative process. The most common follow up treatments are:
cryotherapy and a hydrating facial.
"The cryotherapy treatment is a dry ice treatment that helps remove
flaking and enhances healing. Cryotherapy treatment should be done
four days after your peel. A hydrating facial is recommended four days
after the cryotherapy to protect and moisten your new skin."
Read more about "Medium-Depth Chemical Peeling."
Alpha hydroxy acids
are derived from foods, such as fruits and milk, and are thought to
enhance the texture of skin by removing layers of dead cells and
encouraging cell regeneration. Cosmetics that contain alpha hydroxy
acids (AHAs) have become widely used in recent years despite many
unanswered questions about their safety."
More about Alphahydroxy acids:
Alphahydroxy acids (AHAs), such as glycolic, lactic, or fruit acids
are the mildest of the peel formulas and produce light peels. These
types of peels can provide smoother, brighter-looking skin for people
who can't spare the time to recover from a phenol or TCA peel. AHA
peels may be used to treat fine wrinkling, areas of dryness, uneven
pigmentation and acne. Various concentrations of an AHA may be applied
weekly or at longer intervals to obtain the best result. Your doctor
will make this decision during your consultation and as the treatment
proceeds. An alphahydroxy acid, such as glycolic acid, can also be
mixed with a facial wash or cream in lesser concentrations as part of
a daily skin-care regimen to improve the skin's texture.
is an alpha hydroxy acid derived from the sugar cane plant acts as a
keratolytic (removes top layers of skin) agent and opens clogged
pores. It has been shown in clinical studies to improve acne and the
hyperpigmentation that is present with acne. Start with the lower
strength (2.5% or 5%) preparations first. Strengths above 5% may be
irritating. A gel is usually more drying and stronger than a lotion or
Glycolic Acid is a Fruit acid containing natural chemicals and is
also known as alpha hydroxy acids (AHA). They occur naturally from
certain fruits such as grapes, citrus and apples, which are then
modified in a laboratory.
A substance obtained from plants (white willow back and wintergreen
leaves) and also synthesized which is versatile and possesses
bacteriostatic, fungicidal, and keratolytic actions.......It is a
peeling agent in ointments, creams, gels, and shampoos applied to
reduce the scaling of the skin or scalp in psoriasis. It is the active
ingredient in many skin products for the treatment of acne since it
causes skin cells to slough off more readily, preventing them from
clogging up the pores. Salicylic acid reacts with acetic acid to
acetylsalicylic acid, better known as aspirin. Salicylic acid is also
chemically known as orthohydroxybenzoic acid."
Trichloroacetic acid (TCA)
Trichloroacetic acid (TCA) can be used in many concentrations, but it
is most commonly used for medium-depth peeling. Fine surface wrinkles,
superficial blemishes and pigment problems are commonly treated with
TCA. The results of TCA peel are usually less dramatic than and not as
long-lasting as those of a phenol peel. In fact, more than one TCA
peel may be needed to achieve the desired result. The recovery from a
TCA peel is usually shorter than with a phenol peel.
"With a TCA peel, your healed skin will be able to produce pigment as
always; the peel will not bleach the skin. However, TCA-peel patients
are advised to avoid sun exposure for several months after treatment
to protect the newly formed layers of skin. Even though TCA is milder
than phenol, it may also produce some unintended color changes in the
Trichloroacetic acid (TCA)
* Smooths out fine surface wrinkles
* Removes superficial blemishes
* Corrects pigment problems
* Can be used on neck or other body areas
* May require pre-treatment with Retin-A or AHA creams
* Treatment takes only 10-15 minutes
* Preferred for darker-skinned patients
* Peel depth can be adjusted
* Repeat treatment may be needed to maintain results
* Sunblock must be used for several months
* Healing is usually quick, much quicker than with a phenol peel
* TCA is especially effective in treating darker-skinned patients.
* Can possibly be used to achieve some effects of a deep peel, depending on the
concentration and manner of application.
* Generally shorter recovery time than with a deep (phenol) peel.
Other considerations TCA:
* May require pretreatment with AHA or Retin-A creams.
* Repeat treatment may be required.
* Deeper TCA peel may result in 2-3 days of restricted activity.
"Phenol is the strongest of the chemical solutions and produces a deep
peel. It is used mainly to treat patients with coarse facial wrinkles,
areas of blotchy or damaged skin caused by sun exposure, or
pre-cancerous growths. Since phenol sometimes lightens the treated
areas, your skin pigmentation may be a determining factor as to
whether or not this is an appropriate treatment for you. Phenol is
primarily used on the face; scarring may result if it's applied to the
neck or other body areas.
"With a phenol peel, the new skin frequently loses its ability to make
pigment (that is, tan). This means that not only will the skin be
lighter in color, but you'll always have to protect it from the sun.
Phenol may pose a special risk for patients with a history of heart
disease. It's important that you make your surgeon aware of any heart
problems when your medical history is taken.
"It is also possible that phenol will cause some undesired cosmetic
results, such as uneven pigment changes. Certain modified phenol peels
are gentler and may be preferred in some circumstances.
* Corrects blotches caused by: sun exposure, birth-control pills, aging
* Smooths out coarse wrinkles
* Removes pre-cancerous growths
* Used on the face only
* Not recommended for dark-skinned individuals
* Procedure may pose risk for patients with heart problems
* Full-face treatment may take one hour or more
* Recovery may be slow - Complete healing may take several months
* May permanently remove facial freckles
* Sun protection, including sunblock, must always be used
* Results are dramatic and long-lasting
* Permanent skin lightening and lines of demarcation may occur
"The effectiveness of phenol chemical peeling has been proven in
clinical studies over the last 30 years. Because they are serious
procedures, it is ASAPS? position that phenol chemical peels should
only be performed under the direction of a qualified physician.
An example of a Combination Product
"Medium-depth chemical peeling is defined as controlled damage from a
chemical agent to the epidermis and papillary dermis resulting in
specific regenerative changes that can be performed in a single
setting. Agents currently used include combination products?Jessner's
solution, 70% glycolic acid, and solid carbon dioxide with 35%
trichloroacetic acid. The benchmark for this level peel was 50%
trichloroacetic acid. It has traditionally achieved acceptable results
in ameliorating fine wrinkles, actinic changes, and preneoplasia.
However, since TCA itself is an agent more likely to be fraught with
complications, especially scarring, in strengths of 50% or higher, it
has fallen out of favor as a single agent chemical peel. It is for
this reason that the combination products along with a 35% TCA formula
have been found equally effective in producing this level of control
damage without the risk of side-effects."
Read more about this technique: "Medium-Depth Chemical Peeling."
EXPECTATIONS AFTER A CHEMICAL PEEL
"After a chemical peel, most people experience some facial swelling
and reddening. Your doctor may advise you to keep your head elevated.
"After a Phenol peel, the eyes often swell shut. Following a Phenol
peel, a petroleum jelly or waterproof dressing may be applied to the
treated area. This covering is left on for a day or two. After Phenol
and deep TCA peels, you?ll need to arrange for someone to drive you
home. Ride arrangements do not need to be made after having an AHA or
a light TCA peel."
The recovery period is different for each type of peel.
Light peels: "Alphahydroxy acids (AHAs) AHA peels generally cause some
flaking, redness and dryness, or skin irritation. These side effects
diminish over time. Once the body heals itself naturally, the outer
layer of skin will fall away. Patients are usually able to engage in
normal public activities the day after an AHA peel."
Medium peels: "Trichloroacetic acids (TCA) TCA peels may cause
significant swelling, depending on the potency of the chemical
solution that was used. Swelling should diminish after the first week.
The skin will heal sufficiently to resume normal activities in
approximately 7-10 days."
"After TCA peels, some patients also have outbreaks of small
whiteheads, called milia, which are formed in obstructed facial
glands. Generally, these disappear with washing, but in some cases a
doctor will need to remove them."
Deep peels: "Phenol acid After a Phenol peel, your doctor may
prescribe a mild pain medication to relieve any discomfort. If a
waterproof adhesive is applied to the treated area, it will be removed
in 1-2 days, and you?ll be instructed to cover the area with
antiseptic powder several times a day. A scab will form and, within
7-10 days, new skin will form. While the skin will be red at first,
the color will lighten over a few weeks to a few months."
After any peel, it is critically important that the skin be protected
from the sun. Ask your doctor to recommend a sun block with both UVA
and UVB protection, and apply it daily.
After the procedure, the doctor may recommend that the patient stop
smoking for at least a week. Smoking decreases circulation of the
blood in the skin, which can slow your recovery.
See the Ienhance website
Complications of Chemical peels
"Significant complications with chemical peels are infrequent, but
potential complications include:
* Temporary or permanent changes in skin tone or uneven tone (especially with
Phenol peels). These include
* Hyperpigmentation (a darkening of the skin, treatable in most cases with
current bleaching techniques)
* Hypopigmentation (a lightening of the skin, more difficult to treat)
* Cold sore breakouts in patients who have a history of recurring blisters and
cold sores, like herpes and shingles. (An anti-viral medication before the
procedure can help prevent this.)
* Risks for those with a family history of heart disease (Phenol peel only
"Scarring can occur with strong acids, but is unusual with weaker
ones. The most common causes of scarring are infection, and pulling
off the skin before it is ready to peel. Both of these are avoidable.
There are many companies that now sell "at home" chemical peels. Here
is just one example so that you can get an idea of the variety.
"Skin Culture's active principle ingredients are salicylic acid,
resorcinol and a small percentage of phenol (less than 2% by volume)
as opposed to the medical peelings, which are predominantly phenol.
Salicylic acid, resorcinol, and phenol cause the skin to exfoliate
Contra-indications to Cosmetic Chemical Peel of the one described above:
Developed in 1937 the Skin Culture Peel has been used by tens of
thousands of women and men and is registered with the US Food and Drug
Very rarely will a client have an allergic reaction to the Skin
Culture Peel. The symptoms may include itching, swelling, redness, and
stinging lasting for a few days. You should not have a chemical peel
· You are pregnant or lactating
· You are using Accutane or other dermatological drugs
· You are using Retin-A, which should be discontinued about 30 days before
peeling is administered.
· You have extremely thin or translucent skin.
· You have a history of fever blisters or herpes simplex which can be stimulated
by a chemical peel.
· You have a history of medical problems. (e.g. eczema, seborrhea, psoriasis,
bacterial skin infections and extremely sensitive or hyper-allergic skin).
I hope I have provided you with enough information to obtain a good
understanding of the types of chemical skin peels and the major
ingredients along with the pros and cons associated with each
Also - thank you so much for your speedy clarification. If I can be
of further help, please don't hesitate to ask! I will do what I can.
types of skin or chemical peels
ingredients in skin or chemical peels
phenol for skin peels
Some of the sites utilized:
Skin Therapy Letter
International Rosacea Foundation
Medium-Depth Chemical Peeling
The American Society for Aesthetic Plastic Surgery
British Association of Cosmetic Doctors - Chemical Peeling